Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Improvement in identification of multivessel disease after acute myocardial infarction following stress-recovery analysis of ST depression in the heart rate domain during exercise
WITH THE TECHNICAL ASSISTANCE OF,
Cardiac Rehabilitation Unit, Regional Hospital Sondalo
*Division of Cardiology, ‘Careggi’ Hospital Florence
Division of Cardiology, ‘S. Paolo’ Hospital Milan, Italy
Received 20 September 1993; revised 5 April 1994; .
Correspondence Riccardo Bigi, MD, Cardiac Rehabilitation Unit, Regional Hospital, 23039 Sondalo (SO). Italy
Abstract
The demonstration of extensive coronary artery disease (CAD) after acute myocardial infarction (AMI) has important prognostic implications. Exercise-induced ST segment depression is commonly used for detecting the presence of CAD and evaluating its extension. However, even though there have been many attempts to increase its diagnostic yield, the accuracy of the electrocardiographic signal for identifying multivessel disease (MVD) is relatively low, particularly in post-MI patients.
The aim of this study was to evaluate the ability of a simple index, combining information on the amount and kinetics of ST depression in the heart rate domain during exercise and recovery, to identify MVD after AMI.
Seventy patients (mean age 53.4 years) underwent a bicycle, symptom-limited exercise stress test and coronary angiography 2–3 weeks and 6 weeks respectively, after uncomplicated AMI while cardioactive therapy was discontinued. After obtaining a computer-derived measurement of ST levels based on incremental averaging of normal complexes, the area subtended to baseline and limited by the ST trend against heart rate during both exercise (Al) and recovery (A2) was calculated The difference (A1-A2) was defined as the ‘Stress-Recovery Index’ (SRI) and dichotomized, by means of receiver-operating characteristics curve analysis, at 5 mm x beats. min–1 to define an increased risk of MVD.
The SRI of patients with MVD was significantly lower than that of patients with single vessel disease. The sensitivity of SRI < –5 mm x beats. min–1 (65%) for predicting MVD was significantly higher than that obtained by other conventional parameters, without appreciable loss of specificity (81%). The sensitivity and specificity of SRI for three-vessel disease were 79% (P<0.01 vs other parameters) and 78% respectively.
SRI may improve the identification of MVD in patients with recent AMI, in whom the accuracy of standard electrocardiographic criteria is usually unsatisfactory.
Key Words: Exercise stress testing • coronary artery disease
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